GPS: Curses and some Remedies

The other day, I was driving to a newer destination and somewhere in my journey, the GPS navigation display gave up the ghost, all it would say was…”Searching for satellites.” I looked to see if I was under a canopy of trees, near a mountain, or in a tunnel. None of those criteria were satisfied. I was on a n open road.

Now what?

Fortunately before getting in my car, I had Googled directions to the destination and committed to memory as a redundancy. After a few missed turns and “Recalculating” in my brain, I was able to reach my destination, albeit a little late.

Imagine yourself in the cockpit of an aircraft and the GPS refuses to give up the digital cures. What would you do? The straight and narrow of course is tune the VORs at all times and triangulate your position. Simple enough! But for that you have to have sectional charts or low altitude airways charts, Right? Absolutely! RAIM loss is uncommon but it occurs. Maintenance of satellite feeds are also uncommon but they happen. So the smart flier keeps his brain engaged, his fingers moving the dials and correlates his findings with those of the GPS. The Multifunction Display (MFD) is great but a secondary source of data is always a welcome security blanket. If you are bicoastal flier, turning East or West will take you to the ocean for bearings, easy enough. But in the middle of Nebraska where one stretched out field looks like any other, reliance on other devices, including the compass is a good idea for correlational accuracy and staying engaged. Look outside the window. See the terrain. Do some pilotage periodically. Keep yourself in the know!

Another episode of this navigational saga unfolded the day after, while the GPS navigation was in full functional mode, I missed a turn that it reminded me in its pesky snarly voice, “Turn Right!” I was listening to music at the time. So I took the next turn and now the bossy voice from the GPS said, “Recalculating!” after a brief period it outlined a pathway in solid blue to follow. I did and found that it was circuitous. After 5 minutes it had landed me back to the spot where I had made the turn. What gives? I thought. Well apparently the computer database had not been updated to see the new road connecting my designed path and where I was at the time. The old mind then “recalculated” asked a passerby and taking a few “rights”  and “lefts” I was on my way again.

Now wear the aviation hat of a pilot. What would you do? Suppose errant information inserted into the FMS takes you through a path with higher terrain and you are trying to stay under Visual Flight Rules (VFR) below a cloud deck. Now combine that little fiasco with dimming twilight and haze of fog and now Ground Proximity Warning system. You can see where I am going with this. Remember American Airlines Flight 965 (Boeing 757) that crashed near Buga, Columbia. It was determined by the Special Administrative Unit of Civil Aeronautics as a navigation related accident. Yes, that was a tragedy of great proportions.

http://www.youtube.com/watch?v=O3-szBihvqk

Included is a Cockpit Voice Recorder (CVR) data from inside the cockpit:

2140:56 Captain: Why don't you just go direct to Rozo then, alright?

2140:58 First Officer: OK, let's...

2140:59 Captain: I'm goin' to put that over you.

2141:00 First Officer: ...Get some altimeters, we're out of uh, ten now.

2141:01 Captain: Alright.

2141:02 Cali Approach: Niner six five, altitude?

2141:05 Captain (radio): Nine six five, nine thousand feet.

Right bank of 20 degrees begins to decrease. Flight Level Change disengaged, Vertical Speed and IAS modes engaged, altitude passes 8,600 feet.

2141:10 Cali Approach: Roger, distance now?

2141:15 Cockpit Area Microphone: Terrain, terrain, whoop, whoop...

Pitch attitude 4.5 degrees nose-up, roll attitude is 12 degrees right, airspeed down to 234 knots, rate of descent 1,500 feet per minute, altimeter at 8,480' MSL, radar altimeter at 1,476' AGL. Autopilot disengages. Master Warning activated. Engine EPRs at 1.0.

2141:17 Captain: Oh [expletive]..

2141:17 Cockpit Area Microphone: [Sound of autopilot disconnect warning starts]

2141:18 Captain: ...Pull up baby.

2141:19 Cockpit Area Microphone: [Sound of aircraft stick shaker]

Pitch attitude increases to 31 degrees. Aircraft rolls out of right turn and reaches 13 degrees left bank. Master Caution issued as radar altitude decreased below 500' AGL. EPRs increase to 1.35 as radar altimeter decreases to 109' AGL and airspeed decreases to 187 knots. Landing gear and flaps remain up.

2141:20 First Officer: It's OK.

2141:21 Cockpit Area Microphone: Pull up.

2141:21 Captain: OK, easy does it, easy does it.

2141:22 Cockpit Area Microphone: [Sound of autopilot disconnect warning. Sound of aircraft stick shaker stops]

2141:23 First Officer: Nope.

2141:24 Captain: Up baby...

2141:25 Cockpit Area Microphone: [Sound of aircraft stick shaker starts and continues to impact]

2141:25 Captain: ...More more.

2141:26 First Officer: OK.

2141:26 Captain: Up, up, up.

2141:27 Cockpit Area Microphone: Whoop, whoop, pull up.

End of CVR recording.

So to all who live and die by the flash of technology either as a pilot or driving GPS navigation display installed automobile, a word of advice… Remain engaged! 

"A BET OF SORTS..." (CVS, Obesity, Aviation and Transposons)

What drives human behavior is an argument that has long populated the minds of men and women. Indeed what does?

Is it…?

Ah but then I will give it away too soon.

So let’s look at the social milieu, the push and pull of things and slow emergence of society. Society is dynamic and the equilibria are based on a simple Nash equation. Nothing happens in a social vacuum. Nothing, except a freaked out mind!

We all take risks, don’t we? Of course we do. Getting out of bed to confront a new day is a sort of a potential risk. What dreams might materialize into reality, is the confounding question that haunts the present over the past. You see, there is a certain bet we all make on a daily basis. To each his own bet, though, because living life is an individual enterprise and such thoughts and actions are rarely shared.

Today we learn that obesity is the realm of chronic diseases such as diabetes, heart disease and cancer. All these ailments have a scientific basis to them. The root cause is anchored in inflammation. So why is the populace still indulgent in the cheese-steaks, the donuts, and other excesses? Well there is also perhaps another reason lurking behind the behavior, and we will get to that too in a little…

And while on this unstructured communication let us look at smoking and drinking. Both such societal norms are curses of enormous vehemence against the human health and overall survival. Yet we maintain our path in spite of warnings on billboards, on the back of buses travelling at high speeds and heart rending ads on the television.

So what gives…?

Humans! (Read: Against the Gods: The Remarkable Story of Risk ~ Peter Bernstein)

We are an unstructured evolving beings, gathering, collating, enriching, codes of all assumptions and collection of all experiential referents, which are turned into rhythms that flow into societal behaviors. And we make bets on ourselves, all the while looking and peeking at others. A smoker gathers in the company of other smokers and re-calibrates his or her thinking that there is no harm and what little there is, is ratified in their minds as okay.  He or she finds rationales in archived pseudo-scientific literature to pull data for his or her own mental defense. A type II obese diabetic may find the endorphin release from a sugar rush of a comfort food too difficult to give up. An alcoholic the same! We find solace in the company of other like-minded. That is our inherent religion.

What it is, is the ongoing silent communication within the carefully bounded rationales of the mind!

The other day CVS  decided to take a short term loss for a long term gain benefits to humanity to stop selling cigarettes. It would seem like a good marketing gesture by the company. And all the pundits and experts bowed and prayed to the neon gods they made” that the company found a new religion, with adoration on all fours. But does that really modify the behavior of an individual? I think not. Only education works and a constant flow of real information that people can assimilate and from where they can grow their understanding. So while on its face it might appear a cause celebre. It rarely is.

A similar gesture of “good will” seems to have slid down the Aviation  docket the other day as a “product enhancement” about having pilots with BMI of 40 to undergo a sleep apnea evaluation. This was steeped in no particular study, NTSB finding or for that matter in anything remotely scientific. But there it was. The long arm of the pseudo-science and polity it appears was trying to appease their managerial gods and appear benevolent. It will now as it should require public opinion and a sprinkle of scientific facts before such enactments are deemed mandates. Should obese pilots be grounded? Better yet should obese pilots  undertake some measure of self critique to gain better health? These simple questions simultaneously infringe upon and exploit human endeavor. Mandates are fraught with group-think impositions at best. Appearing to protect by laying down a padded cell is a fragile state that collapses in a heap. It is as Nassim Taleb points out in his book Anti-fragile that human endurance, their survival and "Things that gain from Disorder" are embedded in exposure to and benefiting from risks. The exposure, both experiential and knowledge from others makes us strong! And the longer we mask and hide from the little whips and scorns of life, the more the potential for a calamity - the huge fat tail of a thing! The Transposons (or jumping genes) jump to strengthen the DNA for its survival against the ravages of other microbial life forms. So why this timid stance to create a padded protective cell?

Common sense is rare in today’s circle of intellectuals, especially the “experts” who surround themselves with the same self-fulfilling prophecies of “I am right and you are wrong!”

So in answer to what drives human behavior, question, and the answer you might have guessed by now…it is the Bet of Sorts we all make, against the Odds.

As humans we are all risk takers. It is grafted in our DNA. That is why we landed on the moon and sent the Rover to scope out planet mars. It is why we build things and keep modifying them as we learn our mistakes to make them right. It is why we travel to far away places to learn what was and is over there. It is why we are humans! But Common sense is not that common, because it needs to be cultured. And anyway if you really come down to it...if the middle-man was not paying for the healthcare bills, medical care would be cheap and none of this hue and cry would occupy the media-scape. Now would it? Just a thought.

As Mr. Spock would say:

“Live Long and Prosper!” –and gain Liberty through Knowledge and Understanding.

UNDERSTANDING

Realizing the domain of hazards, transgressions into any venture are replete with the unknowns. There lie the risks of “what could be,” rather than “what should be.” The imperatives of knowing the risks do not minimize the potential of something that is not understood or a hazard that is not known to exist.

Humans live in the wild frontier of the Lewis and Clark expeditions. A snake here, a wild boar there and life ends. Health expectations seem to follow such traditions of the unknown. Even though most pathology is well known, the constant exposure to newness and its interaction with the physiology create the “wild boars.”

Risks

Mitigating risks is the overall desire of all physicians when they undertake the cause of healing. No, it cannot simply be “do this and that will happen.” One has to think the minutia of so many iterant that the multiprocessing brain through experience is most times able to eek out the right answer. And here lies the bleeding reason where not all decisions given the human capacity, are correct. The risks are both from the disease, that compels towards injury and directed medical therapy that has an embedded intolerance to the functions of the individual cell. The balance that permeates between the two is what is considered “success.”

While considering all the nuances of most known risk factors that might rear their ugly heads, a physician then also has to consider the capacity of the patient to relate to the risk of the proposed therapy. For instance, is the treatment more harmful than the disease it is purported to eliminate? Is the individual able to withstand the side effects of the therapy or is he or she in a weakened state of being and that even though the therapy is the correct one with the most benefit, yet the weakened state of the individual, would of necessity certainly endanger the patient. One might also then consider weather the short term benefits of the therapy create the long-term collateral side effects and that whether such a therapy may well not be employed and a lesser or no therapy (placebo) be employed? These are questions of great concern both to the patient and to the physician. As the science of medicine has shown us that the overall benefit has to consider the underlying risk and the capacity of the patient to withstand such therapy. Additionally such proposed therapy should be considered only when short-term benefits do not outweigh the long-term injury to the patient.

Capacity

The physiology and neuro-psychology of an individual at play in this interaction of “to do or not to do,” is of immense importance. An individual’s vanishing immunity within from the pain of the affliction has to be considered in the reasoned efforts by the physician. At times the wisps of such relational issues bear significance, in that minimizing therapy of the patient may have more long-term benefits then otherwise. A weak immune system is ripe for coercion from many potentially devastating ailments, including cancer.

"...to suffer the slings and arrows of outrageous fortune..."

and

"... whips and scorns of time..."

An appropriate example here would be the short-term benefit of corticosteroids and the implications of secondary infections, osteoporosis and suppression of the adrenal gland function. From a orthopedic point of view, one might also review the overuse of steroids within joint cavities and the untoward effects on the ligament weakness and potential rupture.

The weight of this argument is conceived in the thought that before any therapy is embarked upon, a measure must be established between risk, capacity and the true potential benefit to the patient.

Tolerance

At all times in today’s world of “patient-centric decision-making” the patient is a willing and able decision-maker along with his or her physician. It must be so for the proper and ethical undertaking of the care of the patient. However, here we arrive at the slippery slope of the improper effect of this causal behavior. For instance the right therapy may be rejected by the patient through improper understanding or as a result of the short-term side effects from such therapy. A patients self image and ability to withstand the toxic effects to gain the benefits may be conjured in a most negative light and the potential curative intent may be lost. Is the patient then like the consumer (in business world) always right, no matter what the decision? Thus the implied risk of intolerance to proposed therapy then, accidentally becomes the cause of deviating from a path more profitable to the patient? These questions bear a deeper level of understanding. One cannot simply “cut and paste” with the “one size fits all” mode of reasoning.

Acute illnesses

All diseases fall into the categories of “acute” and “chronic.” The former expressly involves a larger share of suddenness of a deviation from a normal existence. The relative change is both sudden and quite disruptive. It carries with it the burden of a lowered threshold of signs and symptoms, where each symptom is perceived excessive and “life-altering.” The intent of the patient is obvious as is that of the physician; to control and mitigate all such complicating insults. The need is great and the desire even greater. Again, even here a balanced reasoning is needed by both parties to reach appropriate results. A patient with a sudden cough, fever and asthenia yearns in today’s world to get their hands on an antibiotic, anticipating an end to their malaise and other symptoms. The physician in an attempt to please may offer such a band-aid, knowing at all times that such therapy will have little or no benefit, yet with that lurking distrust of the unknown is compelled to acquiesce. Here lie the seeds of discontent to so many future ailments. Excessive antibiotic use, especially of the “next-generation” variety, can and usually does make for selective genetic pressures on the offending viral/bacterial/fungal agents. Thus therapy is laying the foundation of a future debacle for human race needing better and better manipulation of the chemical codes to thwart such mutations in these offending infectious agents.

The likes of MRSA, VRE, mutant TB, E-Coli and the like are a testament to such profligate misuse.

Chronic Illnesses

When chronicity compounds the problem, the patient may over time learn to create various means to accept such changes. For instance a low-grade discomfort in the foot may lead to a imbalance at the spine level and create a discopathy creating symptoms of sciatica and more discomfort. Or a chronic inflammation of the stomach treated with “Tums” may be a harbinger of a Helicobacter Pylori infection that precedes a gastric (stomach) lymphoma or a gastric cancer. Long-term acceptance of a low-grade chronic condition can and will at times lead to a worse outcome. Such patients need to be counseled in appropriateness of care and management. All minor complaints, even trivial ones can lead to a profound discovery that can thwart the risk of greater harm down the road of life.

Understanding

Lastly we arrive at the core of proper care; Understanding!

No truer knowledge than a reasoned understanding of the ailment both by the patient and the physician will lead to the best outcomes.

A knowledgeable patient asks the right questions and a knowledgeable physicians offers the correct answers to those questions.

We live in a world of fear and reprisal. We must learn the art of managing these fears and by acknowledging their presence, learn to educate against reprisals. The world is a conjugate of many reflections. A proper understanding circumnavigates such a minefield. It is in the learning of the known that measures of ultimate benefit reside, not in the mindless guidelines and mandates that conform to a closed-loop thinking of the few.

Hey, I didn’t say this was going to be easy!